Chronic Hyperarousal

Chronic Hyperarousal

Under conditions of chronic stress, something goes wrong as the body attempts to cope with this massive overload of responses. The effectiveness of the response diminishes, and the body becomes desensitized to some of the effects of the neurohormones and hypersensitive to others. The entire system can become dysregulated in many different ways. This results in a set of highly dysfunctional and maladaptive brain activities. The person experiences this as a state of chronic hyperarousal. Essentially, the baseline level of arousal for the person has changed and they cannot control their own responses to stimuli.

We all have a "volume control" over our level of arousal. If we are in a lecture hall and hear a noise at the back, we cease paying attention to the speaker and swivel our heads to appraise the source of the noise. Once we are assured that the noise was just a latecomer and that there is nothing to fear, our level of arousal rapidly returns to normal and we are able once again to attend to the lecturer. Our reaction is quite different if we hear a sound, turn our heads and see a man with a gun heading toward the front of the room. In this case we become hyperaroused. This is a clear and present danger, and the fight-flight-freeze response is triggered within each of us.

People who have been severely or repeatedly traumatized may lose this capacity to modulate their level of arousal. Their reaction to the benign latecomer is quite similar to their reaction to the threatening stranger. They stay hyperaroused and guarded; they are unable to calm themselves down even when they see that there is no danger. They feel embarrassed by their response, while at the same time, they are irritable, angry, and frightened for no apparent reason. They are prepared to fight or flee, even though there is no danger. They may also become flooded with memories, images, and sensations that are overwhelming. As a result, they are likely to feel they are "going crazy."This reaction can be triggered by almost anything. Once we have experienced a stimulus that evokesfear we become"fear-conditioned;'a state that is incrediblypowerful and difficult forthelogicalcentersofthebraintooverride. Because of the vastassociational network ofour brains, we can pair fear with virtually anything. This happens atthe time ofthefrighteningevent,beyondconsciouscontrol,andvery quickly. Laterthepersonisusuallynotconsciouslyawareoftheconnectionbetween thefear-provoking stimulus and the fear-response has becomecompletelyautomatic.

Eachepisodeofdangerconnectstoeveryotherepisodeofdangerinour minds, sothatthe more dangerweareexposedto,the more sensitive we become to danger. With each fight-or-flight experience, our mindforms a network of connections that is triggered by every subsequentthreateningexperience or stimulus. Becausewe are so intelligent, these connections can be verywidely linked to any stimulus that is pairedwiththedangerousexperience.

An example canhelpustounderstandthis phenomenon. A manisin a car crash in whichhis wife is severely injured. We would notbesurprisedifhesubsequentlydevelopedhyperarousal when driving or asapassengerinacar.Butwhywould he become hyperarousedwhenever he sees a woman'swristwatch? Only withgreat difficulty does he become aware of thefact that he is being triggered by wristwatches, andonlywithhelpand careful questioning, oreven more specific therapy, does he finally recallthatthelastthinghelaid eyes on before thecrash was the watch on his wife's wrist. His brainhas made theconnectionwithouthisconsciousknowledge. Not only will he unconsciously and self-protectively resist identifying the stimulusofthewatch,buthewilleven more strongly resist remembering theactualeventbecausethememory issohorrifying.Instead,thetriggering may continuewithawideningnetworkofassociations. Wristwatchesmay associate to clocks, or women'sbracelets, or arms. The manmayreachthe point where even leaving his house becomes impossibility because heistooeasilytriggered by stimuli he canneitheridentify nor control. Meanwhile, everyexperienceofhyperarousalfurther compromises andresets his central nervous system.

Now if this sameman discovers somethingthat helpscalmdown this uncontrollablesense of hyperarousal-even temporarily-would we fault himfor utilizing it?Would it be so veryhard for us to understand his dilemma?Alcohol,drugs,sexualactivity,violent acting out, risk-taking behavior, eating excessively, inducing vomiting, purposely hurting thebody,exercising,over-involvement in work-all of these behaviorscan temporarily produce some relieffromthehyperarousal. The problem, of course, isthatthereliefisonly temporary. After withdrawal fromalcohol or other drugs, or otherbehaviors, the agitation rebounds with even greater ferocity. Allof these behaviors can become habitual,even addictive, in such a situation. In this way,coping skillsthat wereinitiallyhighlyadaptivebecomemaladaptivehabits.

If this man seeks treatment, he will likely gettreatedforthe complicating andexacerbatingsymptom-perhapsanxiety, a substance abuse problem, depression, or physicalsymptoms-and the underlying cause is missed. Evenif a clinician or friend does make theconnection,itis just aslikelythatthe man will remain totallyunawareofthe connection, andinfact,that he will protect himself from knowing, and experiencingtheinitial trauma all overagain.

Curriculum

A Trauma-Informed Psychoeducational Group Curriculum

S.E.L.F. represents the four nonlinear, key areas of recovery that provide an organizing framework for the complex problems presented by trauma survivors, by families with problems, and by chronically stressed organizations.

Creating Sanctuary: Toward the Evolution of Sane Societies

Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care

SanctuaryWeb.com

SanctuaryWeb.com is your resource to gain insight into The Sanctuary Model. Research and purchase S.E.L.F Curriculums. Browse and read published articles, as well as, purchase books written by Dr. Sandra L. Bloom.

Sandra L. Bloom, M.D.Associate Professor, Health Management and Policy, Dornsife School of Public Health, Drexel University

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